Adjusting Expectations Redux

Posted on December 6, 2012


Eleven months ago I wrote about how communication between two people can be a challenge because of a major difference in expectations. At that time, I related the story of a critical access hospital (CAH) CEO that, with USDA loans in hand in November 2010, was “ready to begin” his new replacement project…or so I thought. As I did a periodic check in with the hospital months later, I realized “ready to begin” had a different meaning to the two of us. Here he was in January 2012 with nothing to show for the past 15 months except loan money with a lot less buying power. At that time, the CEO said he was “getting ready to break ground in the next 30 days”.

He must have been blessed with the patience of Job.

Fast forward to now, December 2012, eleven months later. The hospital formally announced groundbreaking two weeks ago, with a grand opening in spring 2014. Thirty days became over 300 days.

If the hospital had simply chosen a design-build team in November 2010, it would likely have:

  •  An operational replacement hospital…
  • For 2011 prices…
  • With five months of revenue in the bank, today.

In this case, by the time construction is complete in 2014, the CAH will have forfeited nearly two years’ worth of revenue, in addition to project escalation, which can be crippling. How can an administrator go to bed at night with nothing to show for 26 months of delay? I hope he was not paying interest on those loans since November 2010.

The t.v. or movie scene escapes me.  I recall a conversation where a character reflects back on an event and earnestly questions if he did all he could to get the best result, when he had put out what appeared to many to be a rather pathetic effort. And the character’s friend angrily scolds him with a reply something to the effect that, given the resources he had to work with, even if he achieved an especially extraordinary result he had not adequately achieved his goal. If the CEO above reflects back on his replacement CAH project in April 2014 (assuming it opens on time) and asks a similar question to his CFO, and I was to be the CFO, I would have to hold back the urge to say something to the effect:  “If you opened up the hospital two years ago, you would not have done enough!”

I am not sure what made this particular hospital and leadership team gun-shy. It could have been lack of practice in procuring a project team. It could have been an ineffective RFP process. It could have been the ill-fated decision to hire the local nice-guy architect and / or builder, when a pro should have been used. I can only speculate, but something went terribly wrong.

On some level, scenarios like this are infuriating because they can be avoided and are endemic to the waste and poor decision-making plaguing healthcare today. Schadenfreude is hard to deny. On another level this story is sad and tragic because a community suffered and value was destroyed because of ignorance or lack of courage to try something out of the comfort zone of a particular individual or advisory Board. Was it a failure of mine, in communication, that the CEO did not understand design-build or feel it appropriate?

I am trained to know the limits of what can and cannot be done in design and construction of healthcare facilities. When people tell me they want a project fast, I tell them my company deliver exactly the project they want as fast as they can make decisions. Most of the time that means: ‘I want it fast…but not that fast.’  Let this story be an example and call to arms to healthcare leadership:  have high expectations, know the possibilities and make decisions with courage.